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Sepúlveda-Robles O, Jiménez-Hernández E, Domínguez-Catzín V, Gómez-Flores E, Martín-Trejo JA, Flores-Lujano J, Torres-Nava JR, Núñez-Enríquez JC, De Ita M, Medina-Sanson A, Mata-Rocha M, Morales-Castillo BA, Bravata-Alcántara JC, Nájera-Cortés AS, Sánchez-Escobar N, Peñaloza-Gonzalez JG, Espinosa-Elizondo RM, Flores-Villegas LV, Amador-Sanchez R, Orozco-Ruiz D, Pérez-Saldívar ML, Velázquez-Aviña MM, Merino-Pasaye LE, Solís-Labastida KA, González-Ávila AI, Santillán-Juárez JD, Bekker-Méndez VC, Jiménez-Morales S, Rangel-López A, Rosas-Vargas H, Mejía-Aranguré JM. Analytical study of RUNX1-RUNXT1, PML-RARA, CBFB-MYH11, BCR-ABL1p210 , and KMT2-MLLT3 in Mexican children with acute myeloid leukemia: A multicenter study of the Mexican interinstitutional group for the identification of the causes of childhood leukemia (MIGICCL). Front Pediatr 2022; 10:946690. [PMID: 36452349 PMCID: PMC9702800 DOI: 10.3389/fped.2022.946690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The distribution of RUNX1-RUNXT1, PML-RARA, CBFB-MYH11, BCR-ABL1p210 , and KMT2A-MLLT3 in the pediatric population with acute myeloid leukemia (AML) in many countries of Latin America is largely unknown. Therefore, we aimed to investigate the frequency of these fusion genes in children with de novo AML from Mexico City, which has one of the highest incidence rates of acute leukemia in the world. Additionally, we explored their impact in mortality during the first year of treatment. METHODS We retrospectively analyzed the presence of RUNX1-RUNXT1, PML-RARA, CBFB-MYH11, BCR-ABL1p210 , and KMT2A-MLLT3 by RT-PCR among 77 patients (<18 years) diagnosed with de novo AML between 2019 and 2021 in nine Mexico City hospitals. RESULTS The overall frequency of the fusion genes was 50.7%; RUNX1-RUNXT1 (22.1%) and PML-RARA (20.8%) were the most prevalent, followed by CBFB-MYH11 (5.2%) and BCR-ABL1p210 (2.4%). KMT2A-MLLT3 was not detected. Patients with PML-RARA showed the lowest survival with high early mortality events. However, more studies are required to evaluate the impact of analyzed fusion genes on the overall survival of the Mexican child population with AML. CONCLUSION The pediatric population of Mexico City with AML had frequencies of AML1-ETO, PML-RARA, CBFB-MYH11, and BCR-ABL1p210 similar to those of other populations around the world. Patients with BCR-ABL1p210 and CBFB-MYH11 were few or did not die, while those with MLL-AF9 was not detected. Although patients with PML-RARA had a low survival and a high early mortality rate, further studies are needed to determine the long-term impacts of these fusion genes on this Latino population.
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Affiliation(s)
- Omar Sepúlveda-Robles
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Elva Jiménez-Hernández
- Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | | | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología Pediátrica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaría de Salud de la Ciudad de México, Mexico City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Marlon De Ita
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aurora Medina-Sanson
- Servicio de Hemato-Oncología, Hospital Infantil de México Federico Gómez, Secretaría de Salud (SSa), Mexico City, Mexico
| | - Minerva Mata-Rocha
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Blanca Angelica Morales-Castillo
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Juan Carlos Bravata-Alcántara
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Secretaría de Salud (SSa), Mexico City, Mexico
| | - Alan Steve Nájera-Cortés
- Laboratorio de Genética y Diagnóstico Molecular, Hospital Juárez de México, Secretaría de Salud (SSa), Mexico City, Mexico
| | - Norberto Sánchez-Escobar
- Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca City, Mexico
| | | | | | - Luz Victoria Flores-Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Raquel Amador-Sanchez
- Hospital General Regional No. 1 "Carlos McGregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Darío Orozco-Ruiz
- Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaría de Salud de la Ciudad de México, Mexico City, Mexico
| | - Maria Luisa Pérez-Saldívar
- Unidad de Investigación Médica en Epidemiología Clínica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | | | - Laura Elizabeth Merino-Pasaye
- Servicio de Hematología Pediátrica, Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Karina Anastacia Solís-Labastida
- Servicio de Hematología Pediátrica, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Ana Itamar González-Ávila
- Hospital General Regional No. 1 "Carlos McGregor Sánchez Navarro", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Jessica Denisse Santillán-Juárez
- Servicio de Hemato-Oncología Pediatrica, Hospital Regional 1° de Octubre, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología "Dr. Daniel Méndez Hernández", Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Silvia Jiménez-Morales
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Angélica Rangel-López
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Haydeé Rosas-Vargas
- Unidad de Investigación Médica en Genética Humana, UMAE Hospital de Pediatría, Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Juan Manuel Mejía-Aranguré
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica, Mexico City, Mexico.,Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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El Tekle G, Bernasocchi T, Unni AM, Bertoni F, Rossi D, Rubin MA, Theurillat JP. Co-occurrence and mutual exclusivity: what cross-cancer mutation patterns can tell us. Trends Cancer 2021; 7:823-836. [PMID: 34031014 DOI: 10.1016/j.trecan.2021.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
Cancer is the dysregulated proliferation of cells caused by acquired mutations in key driver genes. The most frequently mutated driver genes promote tumorigenesis in various organisms, cell types, and genetic backgrounds. However, recent cancer genomics studies also point to the existence of context-dependent driver gene functions, where specific mutations occur predominately or even exclusively in certain tumor types or genetic backgrounds. Here, we review examples of co-occurring and mutually exclusive driver gene mutation patterns across cancer genomes and discuss their underlying biology. While co-occurring driver genes typically activate collaborating oncogenic pathways, we identify two distinct biological categories of incompatibilities among the mutually exclusive driver genes depending on whether the mutated drivers trigger the same or divergent tumorigenic pathways. Finally, we discuss possible therapeutic avenues emerging from the study of incompatible driver gene mutations.
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Affiliation(s)
- Geniver El Tekle
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, TI 6500, Switzerland
| | - Tiziano Bernasocchi
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, TI 6500, Switzerland
| | - Arun M Unni
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10065, USA
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, TI 6500, Switzerland
| | - Davide Rossi
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, TI 6500, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona, TI 6500, Switzerland
| | - Mark A Rubin
- Department for BioMedical Research, Precision Oncology Laboratory, University of Bern, Bern, Switzerland; Bern Center for Precision Medicine, University of Bern and Inselspital, Bern, Switzerland
| | - Jean-Philippe Theurillat
- Institute of Oncology Research, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, TI 6500, Switzerland.
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3
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The predictive value of morphological findings in early diagnosis of acute myeloid leukemia with recurrent cytogenetic abnormalities. Leuk Res 2018; 75:23-28. [PMID: 30445236 DOI: 10.1016/j.leukres.2018.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022]
Abstract
This study explores cytomorphologic features and their predictive role for early identification of acute myeloid leukemia (AML) with morphological distinctive recurrent cytogenetic abnormalities (RCA): t(15;17), t(8;21) and inv(16)/t(16;16). We retrospectively evaluated 396 de novo AML cases, diagnosed and treated at single institution, between 2013-2017. Specific cytomorphologic features suggesting distinctive AML-RCA were revealed at diagnosis in 62 (15.65%) patients, including AML with t(15;17) in 41 (66.13%), t(8;21) in 13 (20.97%) and inv(16)/t(16;16) in 8 (12.90%). Final diagnoses of AML-RCA according to WHO integrated diagnostic criteria were established in 66 (16.66%) cases, including AML with t(15;17) 40 (60.60%), t(8;21) 17 (25.76%), and inv(16)/t(16;16) 9 (13.64%). Discordance between cytomorphological and other integrated criteria was detected as missed/wrong-call in 0/1 for t(15;17), 6/2 for t(8;21) and 2/1 for inv(16)/t(16;16). The cytomorphological accuracy was 97.56% (40/41) for t(15;17), 57.89% (11/19) for t(8;21) and 70% (7/10) for inv (16)/t(16;16). Positive/negative predictive values of cytomorphological evaluation were: 97.56%/100% for t(15;17); 84.62%/88.68% for t(8;21); 87.50%/96.65% for inv(16)/t(16;16). Sensitivity/specificity were: 100%/96.15% for t(15;17); 64.10%/95.92% for t(8;21); 77.78%/98.25% for inv(16)/t(16;16). We confirmed that morphology is still a highly relevant evaluation method in diagnosing several common AML-RCAs before completing cytogenetic and molecular studies, enabling early detection, particularly of AML with t(15;17).
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4
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Soni A, Djokic M, Hou JZ, Redner RL, Boyiadzis M. Outcomes of acute myeloid leukemia with t(15;17) not associated with acute promyelocytic leukemia. Leuk Lymphoma 2015; 56:3236-9. [PMID: 25860246 DOI: 10.3109/10428194.2015.1036262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amy Soni
- a Department of Medicine , Division of Hematology/Oncology,University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Miroslav Djokic
- b Department of Pathology , Division of Hematopathology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Jing-Zhou Hou
- a Department of Medicine , Division of Hematology/Oncology,University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Robert L Redner
- a Department of Medicine , Division of Hematology/Oncology,University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Michael Boyiadzis
- a Department of Medicine , Division of Hematology/Oncology,University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center , Pittsburgh , PA , USA
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5
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Trosclair C, Pollen M, Capraro G, Cotelingam J, Shackelford RE. Acute Myelogenous Leukemia without Maturation with a Retinoic Alpha-Receptor Deletion: A Case Report. Case Rep Oncol 2014; 7:407-9. [PMID: 25076892 PMCID: PMC4107820 DOI: 10.1159/000365002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is characterized by a t(15;17) which fuses the 17q retinoic acid alpha-receptor sequence to the 15q PML gene sequence. The resulting fusion product plays a role in the development and maintenance of APL, and is very rarely found in other acute myeloid leukemia (AML) subtypes. Rare complex APL genomic rearrangements have retinoic acid alpha-receptor sequence deletions. Here we report a retinoic acid alpha-receptor sequence deletion in a case of AML without differentiation. To our knowledge, this is the first example of a retinoic acid alpha-receptor sequence deletion in this AML subtype.
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Affiliation(s)
| | - Maressa Pollen
- Department of Pathology, LSU Health Shreveport, Shreveport, La., USA
| | - Gerald Capraro
- Department of Pathology, LSU Health Shreveport, Shreveport, La., USA
| | - James Cotelingam
- Department of Pathology, LSU Health Shreveport, Shreveport, La., USA
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6
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Saito M, Izumiyama K, Mori A, Irie T, Tanaka M, Morioka M, Musashi M. Biphenotypic Acute Leukemia with t(15;17) Lacking Promyelocytic-retinoid Acid Receptor α Rearrangement. Hematol Rep 2013; 5:e16. [PMID: 24416501 PMCID: PMC3883063 DOI: 10.4081/hr.2013.e16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/04/2013] [Accepted: 10/17/2013] [Indexed: 11/23/2022] Open
Abstract
Biphenotypic acute leukemias (BAL) account for less than 4% of all cases of acute leukemia. Philadelphia chromosome and 11q23 rearrangement are the most frequently found cytogenetic abnormalities. Since t(15;17) is almost always associated with acute promyelocytic leukemia, t(15;17) in BAL cases is extremely uncommon. We report here a rare and instructive case of BAL with t(15;17) and the successful treatment approach adopted. A 55-year old woman was referred to our hospital for an examination of elevated white blood cell (WBC) counts with blasts (WBC 13.4×10(9)/L; 76% blasts). The blasts with acute lymphoblastic leukemia (ALL-L2, FAB) morphology co-expressed B-lymphoid and myeloid lineages, and a cytogenetic study revealed 4q21 abnormalities and t(15;17). However, promyelocytic-retinoid acid receptor α rearrangement was not detected by fluorescence in situ hybridization on interphase nuclei. Our patient was treated with chemotherapy for ALL and gemtuzumab ozogamicin without all-trans-retinoic acid, and has remained in hematologic first complete remission for more than 3.7 years.
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Affiliation(s)
- Makoto Saito
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Koh Izumiyama
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Akio Mori
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Tatsuro Irie
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Masanori Tanaka
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Masanobu Morioka
- Department of Internal Medicine and Hematology, Aiiku Hospital , Sapporo
| | - Manabu Musashi
- Department of Internal Medicine, Sapporo Hanazono Hospital , Sapporo, Japan
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7
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A PML/RARA chimeric gene on chromosome 12 in a patient with acute promyelocytic leukemia (M4) associated with a new variant translocation: t(12;15;17)(q24;q24;q11). Med Oncol 2013; 30:409. [DOI: 10.1007/s12032-012-0409-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/08/2012] [Indexed: 12/28/2022]
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8
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Welch JS, Ley TJ, Link DC, Miller CA, Larson DE, Koboldt DC, Wartman LD, Lamprecht TL, Liu F, Xia J, Kandoth C, Fulton RS, McLellan MD, Dooling DJ, Wallis JW, Chen K, Harris CC, Schmidt HK, Kalicki-Veizer JM, Lu C, Zhang Q, Lin L, O'Laughlin MD, McMichael JF, Delehaunty KD, Fulton LA, Magrini VJ, McGrath SD, Demeter RT, Vickery TL, Hundal J, Cook LL, Swift GW, Reed JP, Alldredge PA, Wylie TN, Walker JR, Watson MA, Heath SE, Shannon WD, Varghese N, Nagarajan R, Payton JE, Baty JD, Kulkarni S, Klco JM, Tomasson MH, Westervelt P, Walter MJ, Graubert TA, DiPersio JF, Ding L, Mardis ER, Wilson RK. The origin and evolution of mutations in acute myeloid leukemia. Cell 2012; 150:264-78. [PMID: 22817890 DOI: 10.1016/j.cell.2012.06.023] [Citation(s) in RCA: 1215] [Impact Index Per Article: 101.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 04/27/2012] [Accepted: 06/24/2012] [Indexed: 10/28/2022]
Abstract
Most mutations in cancer genomes are thought to be acquired after the initiating event, which may cause genomic instability and drive clonal evolution. However, for acute myeloid leukemia (AML), normal karyotypes are common, and genomic instability is unusual. To better understand clonal evolution in AML, we sequenced the genomes of M3-AML samples with a known initiating event (PML-RARA) versus the genomes of normal karyotype M1-AML samples and the exomes of hematopoietic stem/progenitor cells (HSPCs) from healthy people. Collectively, the data suggest that most of the mutations found in AML genomes are actually random events that occurred in HSPCs before they acquired the initiating mutation; the mutational history of that cell is "captured" as the clone expands. In many cases, only one or two additional, cooperating mutations are needed to generate the malignant founding clone. Cells from the founding clone can acquire additional cooperating mutations, yielding subclones that can contribute to disease progression and/or relapse.
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Affiliation(s)
- John S Welch
- Department of Medicine, Washington University, St. Louis, MO 63110, USA
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9
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Schmidt-Hieber M, Blau IW, Richter G, Türkmen S, Bommer C, Thiel G, Neitzel H, Stroux A, Uharek L, Thiel E, Blau O. Cytogenetic studies in acute leukemia patients relapsing after allogeneic stem cell transplantation. ACTA ACUST UNITED AC 2010; 198:135-43. [PMID: 20362228 DOI: 10.1016/j.cancergencyto.2010.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/04/2010] [Accepted: 01/12/2010] [Indexed: 11/19/2022]
Abstract
We analyzed karyotype stability in 22 patients with acute leukemia at relapse or disease progression after allogeneic stem cell transplantation (allo-SCT). Karyotypes before and at relapse after allo-SCT were different in 15 patients (68%), the most frequent type being clonal evolution either alone or combined with clonal devolution (13 patients). Patients with and without a karyotype change did not differ significantly in overall survival (OS) (median, 399 vs. 452 days; P = 0.889) and survival after relapse (median, 120 vs. 370 days; P = 0.923). However, acquisition of additional structural chromosome 1 abnormalities at relapse after allo-SCT occurred more frequently than expected and was associated with reduced OS (median, 125 vs. 478 days; P = 0.008) and shorter survival after relapse (median, 37 vs. 370 days; P = 0.002). We identified a previously undescribed clonal evolution involving t(15;17) without PML-RARA rearrangement in an AML patient. We conclude that a karyotype change is common at relapse after allo-SCT in acute leukemia patients. Moreover, our data suggest that additional structural chromosome 1 abnormalities are overrepresented at relapse after allo-SCT in these patients and, in contrast to a karyotype change per se, are associated with reduced OS and shorter survival after relapse.
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Affiliation(s)
- Martin Schmidt-Hieber
- Medical Department III (Hematology, Oncology and Transfusion Medicine), Charité Campus Benjamin Franklin, 12200 Berlin, Germany.
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Management of acute promyelocytic leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood 2008; 113:1875-91. [PMID: 18812465 DOI: 10.1182/blood-2008-04-150250] [Citation(s) in RCA: 594] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The introduction of all-trans retinoic acid (ATRA) and, more recently, arsenic trioxide (ATO) into the therapy of acute promyelocytic leukemia (APL) has revolutionized the management and outcome of this disease. Several treatment strategies using these agents, usually in combination with chemotherapy, but also without or with minimal use of cytotoxic agents, have provided excellent therapeutic results. Cure of APL patients, however, is also dependent on peculiar aspects related to the management and supportive measures that are crucial to counteract life-threatening complications associated with the disease biology and molecularly targeted treatment. The European LeukemiaNet recently appointed an international panel of experts to develop evidence- and expert opinion-based guidelines on the diagnosis and management of APL. Together with providing current indications on genetic diagnosis, modern risk-adapted front-line therapy and salvage treatment, the review contains specific recommendations for the identification and management of most important complications such as the bleeding disorder, APL differentiation syndrome, QT prolongation and other ATRA- and ATO-related toxicities, as well as for molecular assessment of response to treatment. Finally, the approach to special situations is also discussed, including management of APL in children, elderly patients, and pregnant women.
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11
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Owatari S, Uozumi K, Haraguchi K, Ohno N, Tokunaga M, Tokunaga M, Suzuki S, Hanada S, Arima N. A new cytogenetic abnormality, t(2;7)(q33;q36), in acute promyelocytic leukemia. ACTA ACUST UNITED AC 2007; 173:71-4. [PMID: 17284374 DOI: 10.1016/j.cancergencyto.2006.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 08/15/2006] [Accepted: 08/16/2006] [Indexed: 11/25/2022]
Abstract
We report the case of a patient with acute promyelocytic leukemia (APL) carrying a novel chromosomal abnormality, t(2;7)(q33;q36). The 54-year-old woman was morphologically diagnosed with APL through bone marrow aspiration. The proportion of blast cells in bone marrow was 78%, including cells displaying Auer rods and faggot cells. Chromosomal analysis revealed the karyotype 46,XX,t(2;7)(q33;q36)[17]/46,XX[3]. The t(15;17) was not detected with conventional cytogenetic analysis. However, reverse transcriptase-polymerase chain reaction revealed the presence of a PML/RARA fusion gene. Cells displaying t(2;7)(q33;q36) disappeared after complete remission was achieved, using induction chemotherapy. Although several additional chromosomal abnormalities have been reported, this t(2;7)(q33;q36) without the classic t(15;17) represents a novel chromosomal abnormality associated with APL.
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MESH Headings
- Chromosome Banding
- Chromosomes, Human, Pair 2
- Chromosomes, Human, Pair 7
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Karyotyping
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Middle Aged
- Oncogene Proteins, Fusion/genetics
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic/genetics
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Affiliation(s)
- Satsuki Owatari
- Department of Hematology & Immunology, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan.
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12
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Sinha S, Aish L, Oo TH. Morphologic heterogeneity of acute promyelocytic leukemia: therapy-related acute promyelocytic leukemia presenting with FAB-M2 morphology. Am J Hematol 2006; 81:475-6. [PMID: 16680741 DOI: 10.1002/ajh.20577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
MESH Headings
- Adolescent
- Adult
- Aged
- Brachytherapy/adverse effects
- Female
- Humans
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/etiology
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/pathology
- Male
- Middle Aged
- Neoplasm Proteins/genetics
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Oncogene Proteins, Fusion/genetics
- Prostatic Neoplasms/blood
- Prostatic Neoplasms/complications
- Prostatic Neoplasms/drug therapy
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13
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Abstract
Acute promyelocytic leukaemia (APL) with M3 (or M3v) morphology is the only AML subtype to date for which morphology and immunophenotype agree. In other words, FAB M3 is interchangeable with a unique marker profile. More precisely, we have finally recognized a surrogate marker profile for leukaemia derived from the (15;17) translocation and expressing PML/RARalpha transcripts. To present this as a new development may come as a surprise to many. After all, the antigen expression pattern of AML-M3 was well recognized for many years: absence or weak expression of HLA-DR, CD117, CD15, CD11b and CD34 in the context of a myeloid phenotype (CD33 and CD13 expression) and frequently associated with moderate to high side-scatter appearance upon flow cytometric evaluation, depending upon the degree of granularity of the leukaemic cells. While partially correct, this established APL phenotype is both flawed and limited in its ability to distinguish APL from other AML subtypes, such as natural-killer-cell AML. Given the availability of phenotype-specific therapy for APL, such as all-trans retinoic acid or arsenic trioxide, failing to diagnose APL or misdiagnosing a case of AML with an APL-like phenotype will result in serious clinical consequences. Faced with this dilemma, we have recently performed a comprehensive immunophenotypic analysis of APL patients entered on Eastern Cooperative Oncology Group trials. Our results give diagnostic power to only three antigens, HLA-DR, CD11a and CD18, all of which are characteristically expressed at low levels by APL cells. Despite some significant antigenic differences (e.g. in CD34 expression), this surrogate marker profile for t(15;17) APL applies to both the M3 and the M3v FAB phenotypes and to all three isoforms of the PML/RARalpha transcript.
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MESH Headings
- Antigens, Neoplasm/analysis
- Antigens, Surface/analysis
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/immunology
- Gene Expression Regulation, Neoplastic
- Humans
- Immunophenotyping
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/immunology
- Leukemia, Promyelocytic, Acute/pathology
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14
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Liso V, Bennett J. Morphological and cytochemical characteristics of leukaemic promyelocytes. Best Pract Res Clin Haematol 2003; 16:349-55. [PMID: 12935955 DOI: 10.1016/s1521-6926(03)00061-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evaluation of cell morphology is usually sufficient to diagnose acute promyelocytic leukaemia (APL). In this chapter we discuss the features of classical hypergranular APL, the APL variant, hyperbasophilic promyelocytic leukaemia, APL with basophil-like granules, acute eosinophilic leukaemia with PML/RARalpha positivity and the morphology of APL cells lacking t(15;17). In addition to morphological examination, cytochemical investigations (peroxidase chloroacetate-esterase, etc.) may help further in defining the cytology of leukaemic cells in APL.
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Affiliation(s)
- V Liso
- Department of Haematology, University of Bari-Medical School, Policlinico, Piazza G. Cesare 11, Bari 70124, Italy
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15
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Cotter M, Enright H. A novel t(15;17) translocation in acute myeloid leukaemia not associated with PML/RARalpha rearrangement. CLINICAL AND LABORATORY HAEMATOLOGY 2003; 25:255-7. [PMID: 12890166 DOI: 10.1046/j.1365-2257.2003.00529.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a novel t(15;17)(q15;q11) translocation in acute myeloid leukaemia (AML M4) which was not associated with PML/RARalpha rearrangement or with acute promyelocytic leukaemia (APL) morphology. The leukaemia behaved in refractory fashion, with 70% blasts in the bone marrow after the first course of chemotherapy. In view of the refractory behaviour of the leukaemia, the patient was treated with high dose chemotherapy and autologous stem cell rescue. The patient is alive and well 22 months post-autologous stem cell transplant. This case demonstrates that while cytogenetic analysis provides important diagnostic and prognostic information, the precise location of the chromosomal breakpoints is critical in the interpretation of cytogenetic results.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- Chromosome Breakage
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 15/ultrastructure
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, Pair 17/ultrastructure
- Core Binding Factor Alpha 2 Subunit
- Cytarabine/administration & dosage
- DNA-Binding Proteins/genetics
- Daunorubicin/administration & dosage
- Female
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Leukemia, Myelomonocytic, Acute/genetics
- Peripheral Blood Stem Cell Transplantation
- Proto-Oncogene Proteins/genetics
- Remission Induction
- Salvage Therapy
- Thioguanine/administration & dosage
- Transcription Factors/genetics
- Translocation, Genetic
- Transplantation, Autologous
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- M Cotter
- Department of Haematology, Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Ireland.
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16
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Dastugue N. [The interest of standard and molecular cytogenetics for diagnosis of acute leukemia]. PATHOLOGIE-BIOLOGIE 2003; 51:337-45. [PMID: 12927891 DOI: 10.1016/s0369-8114(03)00082-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The standard and molecular cytogenetic techniques now belong to the panel of mandatory analyses performed at diagnosis of acute leukemia. Chromosomal abnormalities contribute to define different types of leukemias and present the major advantage to be effective and independent prognostic factors, essential for therapeutic choices. Cytogenetic techniques allowing to identify hyperdiploïdy >50 chromosomes, t(12;21)(p13;q22)/TEL-AML1(ETV6-CBFA2), t(9;22)(q34;q11)/BCR-ABL, 11q23/MLL, t(15;17)(q22;q12-21)/PML-RARalpha, t(8;21)(q22;q22)/AML1-ETO and inv(16)(p13q22)/ CBFbeta/MYH11 are developed. Among the techniques devoted to study genome, cytogenetics is a basic, simple and effective tool for giving a total picture of the genome through karyotype. Maintaining a systematic cytogenetic analysis is essential, not only because cytogenetics now belongs to routine practice but also because it still contributes to better defining morpho-immunologic sub-types of leukemia, to identify new cytogenetic entities and to understand hematopoiesis and leukemogenesis.
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Affiliation(s)
- N Dastugue
- Génétique des hémopathies, laboratoire d'hématologie, hôpital Purpan, 31059 Toulouse, France.
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17
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Li S, Zhang L, Kern WF, Andrade D, Forsberg JE, Bates FR, Mulvihill JJ. Identification of t(15;17) and a segmental duplication of chromosome 11q23 in a patient with acute myeloblastic leukemia M2. CANCER GENETICS AND CYTOGENETICS 2002; 138:149-52. [PMID: 12505261 DOI: 10.1016/s0165-4608(02)00588-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 32-year-old man was newly diagnosed with acute myelocytic leukemia, classified as acute myeloblastic leukemia with maturation (AML-M2) according to the French-American-British classification system. Conventional chromosome analysis before chemotherapy treatment revealed an abnormal karyotype: a possible segmental duplication of 11q23, plus a translocation between chromosomes 15 and 17 [t(15;17) (q22;q21.1)] in the majority of cells analyzed. Fluorescence in situ hybridization analysis using commercially available probes confirmed the cytogenetic findings. To our knowledge, this is the first report of a combination of t(15;17) and a segmental duplication of 11q23 in a patient with AML-M2.
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MESH Headings
- Adult
- Bone Marrow/pathology
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 17/genetics
- Gene Duplication
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myeloid, Acute/genetics
- Male
- Translocation, Genetic/genetics
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Affiliation(s)
- Shibo Li
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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18
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Grimwade D, Lo Coco F. Acute promyelocytic leukemia: a model for the role of molecular diagnosis and residual disease monitoring in directing treatment approach in acute myeloid leukemia. Leukemia 2002; 16:1959-73. [PMID: 12357347 DOI: 10.1038/sj.leu.2402721] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2002] [Accepted: 06/21/2002] [Indexed: 11/08/2022]
Abstract
Acute promyelocytic leukemia (APL) is characterized by a number of features that underpin the need for rapid and accurate diagnosis and demand a highly specific treatment approach. These include the potentially devastating coagulopathy, sensitivity to anthracycline-based chemotherapy regimens, as well as unique responses to all-trans retinoic acid and arsenic trioxide that have revolutionized therapy over the last decade. The chromosomal translocation t(15;17) which generates the PML-RARalpha fusion gene has long been considered the diagnostic hallmark of APL; however, this abnormality is not detected in approximately 10% cases with successful karyotype analysis. In the majority of these cases, the PML-RARalpha fusion gene is still formed, resulting from insertion events or more complex rearrangements. These cases share the beneficial response to retinoids and favorable prognosis of those with documented t(15;17), underscoring the clinical relevance of molecular analyses in diagnostic refinement. In other cases of t(15;17) negative APL, various chromosomal rearrangements involving 17q21 have been documented leading to fusion of RARalpha to alternative partners, namely PLZF, NPM, NuMA and STAT5b. The nature of the fusion partner has a significant bearing upon disease characteristics, including sensitivity to retinoids and arsenic trioxide. APL has provided an exciting treatment model for other forms of AML whereby therapeutic approach is directed towards cytogenetically and molecularly defined subgroups and further modified according to response as determined by minimal residual disease (MRD) monitoring. Recent studies suggest that rigorous MRD monitoring, coupled with pre-emptive therapy at the point of molecular relapse improves survival in the relatively small subgroup of PML-RARalpha positive patients with 'poor risk' disease. Advent of 'real-time' quantitative RT-PCR technology seems set to yield further improvements in the predictive value of MRD assessment, achieve more rapid sample throughput and facilitate inter- and intra-laboratory standardization, thereby enabling more reliable comparison of data between international trial groups.
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MESH Headings
- Acute Disease
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Humans
- Leukemia, Myeloid/therapy
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/therapy
- Monitoring, Physiologic
- Neoplasm, Residual
- Translocation, Genetic
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Affiliation(s)
- D Grimwade
- Division of Medical and Molecular Genetics, Guy's, King's and St Thomas' School of Medicine, London, UK
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19
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Cassinat B, Chomienne C. Biological features of primary APL blasts: their relevance to the understanding of granulopoiesis, leukemogenesis and patient management. Oncogene 2001; 20:7154-60. [PMID: 11704844 DOI: 10.1038/sj.onc.1204761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In recent years, discovery of the in vitro and in vivo differentiation of APL blasts by all-trans retinoic acid (ATRA) has modified the therapeutic approach of APL and lead to important advances in understanding the biology of APL. Since it became apparent that differentiation therapy of APL with ATRA was indeed a true model of targetted therapy, evidencing the molecular targets of retinoic acid efficacy became crucial. These molecular targets are closely related to the biological features of APL cells, some of which are well-known and have contributed to the morphological and cytogenetic definition of the leukemia, others have just been defined or re-discovered in the light of a better understanding of molecular controls of cell growth and differentiation. The aims of characterizing the biological features of APL cells should allow a better management of APL therapy and the identification of potential markers for differentiation therapies in other leukemias or solid tumors.
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Affiliation(s)
- B Cassinat
- Hopital Saint-Louis, Paris, Institute of Hematology, INSERM E 00-03 France
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20
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Virchis A, Massey E, Butler T, Devaraj P, Wright F, Secker-Walker L, Prentice HG, Mehta A. Acute myeloblastic leukaemias of FAB types M6 and M4, with cryptic PML/RARalpha fusion gene formation, relapsing as acute promyelocytic leukaemia M3. Br J Haematol 2001; 114:551-6. [PMID: 11552979 DOI: 10.1046/j.1365-2141.2001.02989.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Demonstration of either the translocation t(15;17)(q22;q21) or the fusion of PML and RARalpha genes is regarded as diagnostic for acute myeloid leukaemia (AML) of FAB type M3, but has occasionally been seen in other FAB types. We present two such cases. Case 1 presented with FAB type M6 and a complex karyotype involving chromosomes 1, 2, 11 and 17. Bone marrow relapse of FAB type M3 followed autologous bone marrow transplantation. Subsequent marrow dysplasia and an M6 relapse were accompanied by a new cytogenetic clone involving chromosomes X, 2, 4, 6, 7 and 16. Fluorescence in situ hybridization (FISH) of metaphase chromosomes at diagnosis showed insertion of material from chromosome 17 into a 'normal' 15 with juxtaposition of PML and RARalpha. Case 2 presented as AML M4 and relapsed as M3. Cytogenetic analysis at diagnosis and in relapse showed 46,XY,t(15;17)(q22;q11),del(16)(q22). FISH analysis showed this to be a three-way translocation involving chromosomes 15, 16 and 17 again with juxtaposition of PML and RARalpha. Reverse transcription-polymerase chain reaction (RT-PCR) revealed PML/RARalpha fusion at diagnosis, in remission and in first relapse. These examples strengthen the case for RT-PCR screening of all AML patients for these fusion genes.
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MESH Headings
- Adult
- Bone Marrow Transplantation
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Erythroblastic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/genetics
- Leukemia, Myelomonocytic, Acute/therapy
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Neoplasm Proteins/genetics
- Nuclear Proteins
- Promyelocytic Leukemia Protein
- Receptors, Retinoic Acid/genetics
- Recurrence
- Retinoic Acid Receptor alpha
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription Factors/genetics
- Translocation, Genetic
- Transplantation, Autologous
- Tumor Suppressor Proteins
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Affiliation(s)
- A Virchis
- Department of Haematology, The Royal Free and University College School of Medicine, Royal Free Campus, University College London, UK.
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21
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Grimwade D. The clinical significance of cytogenetic abnormalities in acute myeloid leukaemia. Best Pract Res Clin Haematol 2001; 14:497-529. [PMID: 11640867 DOI: 10.1053/beha.2001.0152] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During the last three decades it has become apparent that the majority of cases of acute myeloid leukaemia (AML) are characterized by at least one of a variety of recurrent chromosomal abnormalities. These changes have been found in many instances to correlate closely with distinct morphological features and clinical characteristics, the molecular basis of which is becoming increasingly understood. Furthermore, diagnostic karyotype has been shown to be a key determinant of outcome in AML, with mounting evidence to support the notion that cytogenetic analysis can serve to identify biologically distinct subsets of disease that demand tailored therapeutic approaches. This has led to a rising trend towards routine cytogenetic and molecular characterization of newly diagnosed acute leukaemia, providing a framework for treatment stratification.
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Affiliation(s)
- D Grimwade
- Division of Medical and Molecular Genetics, Guy's, King's & St Thomas' School of Medicine, London, UK
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22
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Chauffaille ML, Figueiredo MS, Beltrani R, Antunes SV, Yamamoto M, Kerbauy J. Acute promyelocytic leukemia: the study of t(15;17) translocation by fluorescent in situ hybridization, reverse transcriptase-polymerase chain reaction and cytogenetic techniques. Braz J Med Biol Res 2001; 34:735-43. [PMID: 11378661 DOI: 10.1590/s0100-879x2001000600006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute promyelocytic leukemia (AML M3) is a well-defined subtype of leukemia with specific and peculiar characteristics. Immediate identification of t(15;17) or the PML/RARA gene rearrangement is fundamental for treatment. The objective of the present study was to compare fluorescent in situ hybridization (FISH), reverse transcriptase-polymerase chain reaction (RT-PCR) and karyotyping in 18 samples (12 at diagnosis and 6 after treatment) from 13 AML M3 patients. Bone marrow samples were submitted to karyotype G-banding, FISH and RT-PCR. At diagnosis, cytogenetics was successful in 10 of 12 samples, 8 with t(15;17) and 2 without. FISH was positive in 11/12 cases (one had no cells for analysis) and positivity varied from 25 to 93% (mean: 56%). RT-PCR was done in 6/12 cases and all were positive. Four of 8 patients with t(15;17) presented positive RT-PCR as well as 2 without metaphases. The lack of RT-PCR results in the other samples was due to poor quality RNA. When the three tests were compared at diagnosis, karyotyping presented the translocation in 80% of the tested samples while FISH and RT-PCR showed the PML/RARA rearrangement in 100% of them. Of 6 samples evaluated after treatment, 3 showed a normal karyotype, 1 persistence of an abnormal clone and 2 no metaphases. FISH was negative in 4 samples studied and 2 had no material for analysis. RT-PCR was positive in 4 (2 of which showed negative FISH, indicating residual disease) and negative in 2. When the three tests were compared after treatment, they showed concordance in 2 of 6 samples or, when there were not enough cells for all tests, concordance between karyotype and RT-PCR in one. At remission, RT-PCR was the most sensitive test in detecting residual disease, as expected (positive in 4/6 samples). An incidence of about 40% of 5' breaks and 60% of 3' breaks, i.e., bcr3 and bcr1/bcr2, respectively, was observed.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Child
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 17/genetics
- Electrophoresis, Agar Gel
- Female
- Gene Rearrangement
- Genetic Techniques
- Humans
- In Situ Hybridization, Fluorescence/methods
- Karyotyping/methods
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Male
- Middle Aged
- Neoplasm, Residual/diagnosis
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
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Affiliation(s)
- M L Chauffaille
- Disciplina de Hematologia e Hemoterapia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 04023-900 São Paulo, SP, Brazil.
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23
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Strehl S, König M, Mann G, Haas OA. Multiplex reverse transcriptase-polymerase chain reaction screening in childhood acute myeloblastic leukemia. Blood 2001; 97:805-8. [PMID: 11157501 DOI: 10.1182/blood.v97.3.805] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To determine the incidence of leukemia-specific rearrangements, 60 cases of childhood acute myeloblastic leukemia and transient myeloproliferative disorder were screened with a novel multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) assay, and the results were correlated with the cytogenetic findings. The RT-PCR assay detects 28 different fusion genes and more than 80 different fusion transcript variants. RNA was isolated from methanol/acetic acid-fixed cells that had been routinely prepared for cytogenetic analysis. Nine different fusion transcripts were found in 40% of the cases, whereas 78.3% of the cases had abnormal karyotypes. Two cases with a t(6;11) and an MLL/AF6 gene fusion were missed cytogenetically. Conversely, cytogenetic analysis revealed 10 other well-defined chromosome rearrangements. Although cytogenetic analysis reveals a much broader range of abnormalities, multiplex RT-PCR serves as quality control and provides the essential information for minimal residual disease studies. Moreover, discrepant findings lead to the detection of new rearrangements on the molecular genetic level.
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Affiliation(s)
- S Strehl
- Children's Cancer Research Institute (CCRI) and the Ludwig- Boltzmann Institute for Cytogenetic Diagnosis (LBICD), St Anna Children's Hospital, Vienna, Austria
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24
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Villamor N, Costa D, Aymerich M, Esteve J, Carrió A, Rozman M, Aguilar JL, Falini B, Montserrat E, Campo E, Colomer D. Rapid diagnosis of acute promyelocytic leukemia by analyzing the immunocytochemical pattern of the PML protein with the monoclonal antibody PG-M3. Am J Clin Pathol 2000; 114:786-92. [PMID: 11068554 DOI: 10.1309/j6pu-3xy6-r0c3-nw26] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The fusion protein, promyelocytic leukemia-retinoic acid receptor (PML-RAR)alpha, generated by the t(15;17) translocation has an abnormal cellular distribution with colocalization of RARalpha and PML proteins. We analyzed the immunostaining pattern of PML protein using the PG-M3 monoclonal antibody directed against the amino terminal portion of PML (retained in wild-type PML and PML-RARalpha fusion protein) in the diagnosis of acute promyelocytic leukemia (APL). In addition, we compared this test with other methods for detecting the PML-RARalpha fusion gene. A normal immunostaining pattern was observed in nonmyeloid disorders and in 78 of 111 acute myeloid leukemias (AMLs). A microgranular pattern was observed in 25 AMLs, all corresponding to APL. These results were concordant with the reverse transcriptase-polymerase chain reaction results for PML-RARalpha fusion gene. Only 1 case positive for the PML-RARalpha transcript showed a normal protein pattern by immunocytochemistry. PML immunostaining was helpful to rapidly differentiate 7 cases with borderline characteristics and to obtain the diagnosis in 2 cases with scarce material. The effectiveness and low cost of this technique support its routine use as a first-line procedure in the differential diagnosis of AML.
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MESH Headings
- Antibodies, Monoclonal
- Chromosomes, Human, Pair 10
- Chromosomes, Human, Pair 15
- Chromosomes, Human, Pair 17
- Cytogenetics
- Fluorescent Antibody Technique
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/genetics
- Neoplasm Proteins/analysis
- Neoplasm Proteins/genetics
- Nuclear Proteins
- Oncogene Proteins, Fusion/analysis
- Oncogene Proteins, Fusion/genetics
- Promyelocytic Leukemia Protein
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription Factors/analysis
- Translocation, Genetic
- Tumor Suppressor Proteins
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Affiliation(s)
- N Villamor
- Department of Pathology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Postgraduate School of Hematology Farreras-Valentí, Universitat de Barcelona, Spain
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25
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Grimwade D. The pathogenesis of acute promyelocytic leukaemia: evaluation of the role of molecular diagnosis and monitoring in the management of the disease. Br J Haematol 1999; 106:591-613. [PMID: 10468848 DOI: 10.1046/j.1365-2141.1999.01501.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D Grimwade
- Division of Medical and Molecular Genetics, Guy's, King's and St Thomas' School of Medicine,, Department of Haematology, London
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